Adverse effects NCLEX-RN Practice Questions sharpen your ability to recognize, prioritize, and manage medication-related complications within the Pharmacological & Parenteral Therapies domain. These questions focus on early detection of life-threatening reactions (e.g., anaphylaxis, angioedema), dose-related toxicities (e.g., digoxin, lithium, theophylline), infusion-related syndromes (e.g., red man syndrome), and hematologic, hepatic, renal, and neuroendocrine adverse effects. You will also review IV complications such as infiltration/extravasation and high-risk combinations that precipitate serotonin syndrome, hypertensive crisis, or excessive bleeding. Each item emphasizes assessment cues, critical lab thresholds, safe nursing actions, and escalation strategies. Use these NCLEX-level questions to build clinical judgment, anticipate complications, and intervene promptly to protect patient safety.
Q1. A client taking lisinopril reports swelling of the lips and tongue and difficulty swallowing. Which action should the nurse take first?
- Notify the provider and document the reaction at the end of the shift
- Administer diphenhydramine and continue monitoring the client
- Discontinue the medication, maintain airway, and prepare for possible epinephrine
- Reassure the client that cough is a common side effect of ACE inhibitors
Correct Answer: Discontinue the medication, maintain airway, and prepare for possible epinephrine
Q2. A client on warfarin presents with bleeding gums and an INR of 4.8. What is the nurse’s priority action?
- Administer the next dose of warfarin as scheduled
- Hold warfarin and prepare to administer vitamin K per orders
- Encourage increased intake of leafy green vegetables immediately
- Document findings and recheck INR in one week
Correct Answer: Hold warfarin and prepare to administer vitamin K per orders
Q3. A client on unfractionated heparin has platelets that dropped from 250,000 to 80,000/mm³ in two days. Which action is most appropriate?
- Increase the heparin infusion rate to maintain anticoagulation
- Stop heparin immediately and notify the provider of suspected HIT
- Administer aspirin to prevent further clot formation
- Switch to low-molecular-weight heparin and continue therapy
Correct Answer: Stop heparin immediately and notify the provider of suspected HIT
Q4. During a vancomycin infusion, the client develops flushing of the face and neck, pruritus, and hypotension. What is the nurse’s first action?
- Stop the infusion and assess the client’s airway and vital signs
- Continue the infusion and administer acetaminophen
- Document a penicillin allergy in the medical record
- Increase the infusion rate to finish more rapidly
Correct Answer: Stop the infusion and assess the client’s airway and vital signs
Q5. A postoperative client on morphine PCA is difficult to arouse with a respiratory rate of 8/min and SpO₂ of 88%. Which intervention is priority?
- Increase IV fluids to enhance circulation
- Stop the PCA, stimulate the client, and prepare to administer naloxone
- Reposition the client and continue to monitor
- Encourage deep breathing and coughing exercises
Correct Answer: Stop the PCA, stimulate the client, and prepare to administer naloxone
Q6. A client taking clozapine reports sore throat and fever. Which laboratory result requires the most immediate action?
- Absolute neutrophil count 900/mm³
- Hemoglobin 11.8 g/dL
- Platelets 170,000/mm³
- WBC 7,800/mm³
Correct Answer: Absolute neutrophil count 900/mm³
Q7. A client on atorvastatin reports severe muscle pain and dark, tea-colored urine. What is the best response?
- Reassure that myalgias are expected and encourage continued exercise
- Advise taking the statin in the morning instead of bedtime
- Hold the medication and notify the provider for suspected rhabdomyolysis
- Increase dietary potassium intake to reduce cramps
Correct Answer: Hold the medication and notify the provider for suspected rhabdomyolysis
Q8. A client on digoxin has nausea, blurred vision with yellow halos, and an apical pulse of 48/min. The digoxin level is 2.6 ng/mL. What should the nurse do?
- Administer the scheduled dose and recheck level in the morning
- Hold digoxin and notify the provider of possible toxicity
- Give atropine and continue the digoxin
- Administer potassium-wasting diuretics to lower serum potassium
Correct Answer: Hold digoxin and notify the provider of possible toxicity
Q9. A client treated with lithium for bipolar disorder develops diarrhea, ataxia, and coarse tremor. The most recent level is 1.9 mEq/L. What is the priority action?
- Hold the dose and initiate IV fluids as prescribed
- Administer the next dose with food to reduce GI upset
- Encourage a low-sodium diet to enhance lithium effect
- Instruct the client to increase exercise to reduce tremor
Correct Answer: Hold the dose and initiate IV fluids as prescribed
Q10. A nurse reviews medications for a client on theophylline. Which concurrent medication increases risk of theophylline toxicity?
- Aluminum hydroxide
- Cimetidine
- Docusate sodium
- Sucralfate
Correct Answer: Cimetidine
Q11. A client started on phenytoin develops a widespread rash with mucosal involvement. What is the nurse’s best action?
- Apply emollients and continue therapy
- Hold phenytoin and notify the provider for suspected Stevens-Johnson syndrome
- Administer diphenhydramine and document the rash
- Switch to extended-release phenytoin formulation
Correct Answer: Hold phenytoin and notify the provider for suspected Stevens-Johnson syndrome
Q12. A client on carbamazepine presents to clinic. Which finding requires priority intervention?
- Mild dizziness on standing
- White blood cell count of 2,000/mm³
- Gingival bleeding with brushing
- Mild nausea after meals
Correct Answer: White blood cell count of 2,000/mm³
Q13. A client on isoniazid therapy for latent TB reports fatigue, anorexia, and dark urine. Which lab supports an adverse drug effect?
- ALT 248 U/L
- Potassium 3.8 mEq/L
- Creatinine 0.8 mg/dL
- TSH 2.1 μIU/mL
Correct Answer: ALT 248 U/L
Q14. A client receiving amphotericin B shows a creatinine increase from 0.9 to 2.1 mg/dL and potassium of 3.0 mEq/L. What should the nurse do?
- Continue the infusion and recheck labs in 48 hours
- Stop the infusion and notify the provider of nephrotoxicity
- Administer furosemide to increase urine output
- Restrict fluids to prevent volume overload
Correct Answer: Stop the infusion and notify the provider of nephrotoxicity
Q15. A client takes lisinopril and spironolactone. Which ECG finding suggests a dangerous adverse effect?
- Prominent U waves
- Peaked T waves
- Prolonged QT interval
- Sinus tachycardia
Correct Answer: Peaked T waves
Q16. After using albuterol via MDI, a client reports tremors and palpitations. The nurse should respond by stating:
- These are expected effects; use before activity as prescribed
- Stop the medication immediately and come to the ED
- Increase the number of puffs to overcome the palpitations
- Switch to long-acting beta-agonist monotherapy
Correct Answer: These are expected effects; use before activity as prescribed
Q17. A client with type 1 diabetes is started on propranolol. Which sign of hypoglycemia will still be apparent despite beta-blockade?
- Tachycardia
- Tremors
- Diaphoresis
- Palpitations
Correct Answer: Diaphoresis
Q18. A client on nitroprusside infusion for hypertensive emergency develops confusion, headache, and metabolic acidosis. Which is the priority action?
- Increase infusion rate to improve cerebral perfusion
- Stop the infusion and notify the provider for possible cyanide toxicity
- Administer mannitol to reduce intracranial pressure
- Switch to nitroglycerin transdermal patch
Correct Answer: Stop the infusion and notify the provider for possible cyanide toxicity
Q19. A client receiving total parenteral nutrition develops excessive thirst, polyuria, and blurred vision. What adverse effect should the nurse suspect?
- Refeeding syndrome
- Hypoglycemia
- Hyperglycemia
- Electrolyte depletion of calcium
Correct Answer: Hyperglycemia
Q20. A client on gentamicin reports tinnitus and has a rising creatinine. Which action is most appropriate?
- Administer an additional dose to maintain peak levels
- Hold the dose and notify the provider to evaluate trough levels
- Encourage increased fluid intake and continue therapy
- Switch to another aminoglycoside
Correct Answer: Hold the dose and notify the provider to evaluate trough levels
Q21. A client taking high-dose furosemide complains of muscle weakness. Which assessment supports a drug adverse effect?
- Serum potassium 2.9 mEq/L
- Serum sodium 140 mEq/L
- Serum magnesium 2.0 mg/dL
- Blood glucose 92 mg/dL
Correct Answer: Serum potassium 2.9 mEq/L
Q22. A client receives insulin before breakfast and becomes diaphoretic, shaky, and anxious mid-morning. Which is the best immediate intervention?
- Administer 15 g of fast-acting carbohydrate
- Give long-acting insulin to stabilize glucose
- Encourage water intake and reassess in 30 minutes
- Call the provider for IV dextrose order without further assessment
Correct Answer: Administer 15 g of fast-acting carbohydrate
Q23. A client on phenelzine ate aged cheese and now has severe occipital headache and hypertension. What adverse reaction is suspected?
- Serotonin syndrome
- Hypertensive crisis due to tyramine interaction
- Neuroleptic malignant syndrome
- Hypotensive crisis from MAOI overdose
Correct Answer: Hypertensive crisis due to tyramine interaction
Q24. A client on sertraline starts linezolid therapy. Which combination effect is the priority concern?
- Ototoxicity
- Serotonin syndrome with hyperreflexia and fever
- QT interval shortening
- Severe constipation
Correct Answer: Serotonin syndrome with hyperreflexia and fever
Q25. A client on haloperidol has a temperature of 39.7°C (103.5°F), severe rigidity, and altered mental status. What is the nurse’s priority?
- Administer antipyretics and continue haloperidol
- Stop haloperidol, notify provider, and prepare for supportive care and dantrolene
- Provide cooling blanket and reassess in 4 hours
- Administer benztropine and continue monitoring
Correct Answer: Stop haloperidol, notify provider, and prepare for supportive care and dantrolene
Q26. A client stabilized on warfarin is prescribed trimethoprim-sulfamethoxazole for UTI. What is the best nursing action?
- Continue both medications without changes
- Hold warfarin for 24 hours and reassess pain
- Notify the provider due to increased bleeding risk and anticipate INR monitoring
- Encourage increased vitamin K intake to compensate
Correct Answer: Notify the provider due to increased bleeding risk and anticipate INR monitoring
Q27. A client on hydrochlorothiazide reports lethargy and confusion. Which laboratory value indicates an adverse effect requiring action?
- Sodium 128 mEq/L
- Chloride 104 mEq/L
- Calcium 9.4 mg/dL
- Uric acid 6.0 mg/dL
Correct Answer: Sodium 128 mEq/L
Q28. The nurse reviews new prescriptions. Which combination should be questioned due to high risk of profound sedation and respiratory depression?
- Acetaminophen and ondansetron
- Oxycodone and diazepam
- Metformin and lisinopril
- Atorvastatin and ezetimibe
Correct Answer: Oxycodone and diazepam
Q29. A client on a norepinephrine infusion via peripheral IV develops a cool, pale, and painful IV site with blanching. What is the nurse’s immediate action?
- Stop the infusion and notify the provider for possible extravasation
- Apply warm moist compresses and continue the infusion
- Elevate the extremity and increase the infusion rate
- Flush the IV briskly with normal saline
Correct Answer: Stop the infusion and notify the provider for possible extravasation
Q30. Ten minutes after a packed RBC transfusion starts, the client reports chills, low back pain, and has hypotension. What is the priority action?
- Slow the infusion and reassess in 15 minutes
- Stop the transfusion, keep the IV open with normal saline using new tubing, and notify the provider
- Administer acetaminophen and continue the transfusion
- Elevate the head of bed and administer oxygen only
Correct Answer: Stop the transfusion, keep the IV open with normal saline using new tubing, and notify the provider
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